PB2429: A PROGNOSTIC MODEL FOR EPILEPTIC SEIZURES IN PATIENTS FOLLOWING ALLOGENEIC HAEMATOPOIETIC STEM CELL TRANSPLANTATION: A RETROSPECTIVE COHORT STUDY
Authors: Xiao-Hui Zhang, Yin Zhu
Journal: HemaSphere (2023)

Topic: 22. Stem cell transplantation - Clinical Background: With hematopoietic stem cell transplantation more and more widely used to treat hematopathy and some other diseases, the related CNS complications are gaining more concern. Epileptic seizures (ES) are an unusual complication after transplantation. The exact pathogenesis of ES has not been clarified. According to former studies, it might be related to drug toxicity such as busulfan or tacrolimus used in pre-conditioning, metabolism, infiltration of central nervous system etc. At present, there are many articles on epilepsy and central nervous system complications after transplantation, but there are few articles on epilepsy after transplantation to describe its prognostic effect, incidence, etc. Aims: This study aims to study epilepsy’s possible causes, risk factors, and effect on prognosis systematically among allo-HSCT patients. Methods: In this article, we retrospectively collected data from patients who received allogeneic haematopoietic stem cell transplantation in our center from 2000.1.1 to 2022.12.31. First, these patients were divided into 2 groups—the survival group and the death group. Chi-square for categorical variables and t-test for continuous variables were used to screen out possible risk factors that lead to poor outcome. Then these patients were further divided into two groups according to the time of diagnosis. A total of 182 patients diagnosed from 2012 to 2022 were included in the derivation group, and 74 patients diagnosed from 2000 to 2011 were included in the validation group. Chi-square test and T-test showed no difference between the two groups. We first used univariate logistic regression to screen out factors with significant difference which were afterwards put into the multivariate analysis to build the final model. After the model were built, we draw the ROC and calculate the AUC to evaluate its function. We then drew the calibration curve and decision curve to evaluate the performance of the model. Results: From 2001.1.1 to 2022.12.31, 256 patients of those having undergone allo-HSCT developed epilepsy, and 91 patients died. Between the death and survival group, gender of donors and recipients, transplant times, cause of ES, age of onset, MNC, median engraftment time of WBC showed significant difference. Through univariate analysis, age of onset, number of transplants, and cause of epilepsy were identified as risk factors for ES after transplantation. Through multivariate analysis, six factors entered the final model: age of onset, cause of epilepsy, sex of donor and recipient, transplanted MNC, the median engraftment time of WBC, and blood pressure fluctuation. The area under the curve was 0.772 (95% CI: 0.6816-0.862) for the derivation group and 0.724 (95% CI: 0.5682-0.8803) for the validation group. The calibration curve showed high consistency between the predicted and observed outcomes. A decision curve analysis indicated that ES patients could benefit from the clinical application of the prognostic model. Summary/Conclusion: Allo-HSCT patients with ES who take place at a younger age, caused by drugs, mismatch of sex of donor and recipient, lower transplanted MNC, delayed engraftment of WBC and elevated blood pressure have poorer outcomes. The identification of ES patients with a poor prognosis after allo-HSCT might allow for timely treatment and improve patient survival and outcomes.Keywords: Allogeneic hematopoietic stem cell transplant